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This past July, a Quebec woman died following a detoxification treatment (which included being covered in mud and wrapped in plastic) at a spa near Montreal. In 2004, entertainer Paula Abdul received a manicure that cost her a year of painful thumb infections, linked to unclean equipment at a U.S. nail salon.

Following such high-profile stories, one Calgary doctor is urging spa-goers to remember that many services are not regulated by the government — meaning safety and sanitation is left up to spa owners and workers.

“If you were going for a medical procedure, you would never think that the instruments in the hospital wouldn’t be properly sterilized,” says Wendy Smeltzer, a Calgary doctor who has a special interest in esthetic medicine, including facials, Botox and fillers.

“Procedures such as manicures and pedicures require technicians to cut close to the cuticle area. They’re dealing with body parts that can be nicked; bleeding and infections can happen. Yet, there is no set standard in Canada on sterilization.”

Since 2003, when the British Columbia government deregulated the beauty spa industry, anyone can open a beauty salon offering a range of services performed by people with no qualifications.

Smeltzer was a family doctor in private practice and at Foothills Hospital before founding Sante Spa in Calgary more than a decade ago.

“When I started in the medical spa business, I began to realize there was no one really guiding and leading medical standards in the spa industry,” she says.

Non-medical spa treatments, such as pedicures, manicures and facials, aren’t regulated by the College of Physicians and Surgeons of Alberta or B.C.

There’s no standardized testing for those who perform them and there are no health regulations surrounding equipment. Claudia Kurzac, manager of environmental health at Vancouver Coastal Health, says that anyone could open a spa in B.C. without qualifications.

“You or I could open a spa tomorrow if we had the money,” she said, adding health inspectors visit spas every two years — more if it changes hands. They follow the Public Health Act. “If we determine there is a health hazard, there is action we can take in the form of orders and closures.”

The Beauty Council of B.C. is a voluntary trade association for spa owners and operators. CEO Tara Gilbert says most of their 7,000 members are trained and do get certified by the Beauty Council. They also agree to adhere to the council’s code of conduct. But there are many non-members operating in B.C. Some municipalities, including Surrey, New Westminster and North Vancouver have recently decided to draft bylaws requiring spa and salon owners (but not staff) to get certified by the Beauty Council.

The Beauty Council has also recently launched a program similar to the food industry’s Food Safe program. Called Beauty Safe, it is a test technicians can take to determine their knowledge of basic safety procedures. But there is no guarantee that once they take the test, they will follow proper procedures, Gilbert says, adding she believes the industry should be regulated.

However, Kurzac says regulations can be slow to catch up to a constantly changing industry. She believes the broader outcome-based guidelines and best practices developed by the Health Authorities can more quickly adapt. For example, health authorities across the province banned fish pedicures — in which live fish nibble at the dead skin on your feet — before they were introduced due to concerns that a foot bath full of fish could not be sanitized between uses. Regulations would normally have come much later.

In the absence of Canadian standards, Smeltzer joined the founding board of the Leading Spas of Canada, a group that sets industry health and safety standards, where she’s been instrumental in setting up voluntary standards and an inspection program for spas.

She also sits on the board of the Canadian Association of Aesthetic Medicine, the voice for physicians practicing esthetic medicine.

A priority for Smeltzer is for all spas to put any tools they reuse through an autoclave cleansing process (the same method used by dentists and hospitals), which many spas don’t use.

“Alcohol is not enough, nor is soap and water when cleaning spa tools. An autoclave is the only tool that truly sterilizes equipment of bacteria, fungus and virus,” Smeltzer says, adding that unsterilized instruments can leave a spa client vulnerable to a variety of infections and viruses, including hepatitis and even HIV.

Kurzac says Vancouver Coastal Health considers manicures and pedicures to be low-risk procedures, because they don’t intentionally puncture the skin. As such, they do not require the tools to be autoclaved as they do for tattoo tools. They do require a high level disinfection. That means soaking the tools for a minimum of 20 minutes in a chlorine-based solution.

“That kills most of the micro-organisms,” she said. “Yeah, it is not going to kill 100 per cent, but I wonder how many complaints of illnesses of this nature there have been.”

Smeltzer would also like to see every spa in Canada join the Leading Spas of Canada and complete its standards and practices certification process.

Spas that take part — including Chi Spa at the Shangri-La Hotel and Undines Spa in Chilliwack — have signed up of their own accord.

Undine Miller, owner and operator of Undines, says she wanted to join Leading Spas because she wanted to be part of an organization that keeps tabs on the industry. The industry needs this because the various esthetics schools teach different standards.

“There are a few out there that are just not abiding by that so it would be really great to have some kind of governing body that is an umbrella for the spa industry.”

Miller signed up for the LSC’s quality assurance program a year ago. It wasn’t cheap, she says which she believes shows her commitment to do the right thing for her clients. Her spa was inspected and recommendations made for improvements. “It was quite rigorous and involved,” she said.

Smeltzer says if spas aren’t regulated by the government, then it’s time for the industry to begin playing watchdog. The Beauty Council’s Gilbert says Leading Spas code of conduct is “definitely solid,” but it is still an honour system. But if consumers seek out member spas that will help.

“[For] the people who are doing the right things, it costs more money and it takes more time. But they should be the ones who prosper.”

Ask these questions when you visit a spa or nail salon, advises Tara Gilbert, CEO of the Beauty Council of B.C.

Have you and your staff been certified by the Beauty Council?

Salon owners and staff are not required to be certified to work or own a salon or spa in Vancouver. However Surrey, New West and North Vancouver recently decided to draft bylaws requiring owners (but not staff) to be certified by the Beauty Council.

Do you use an autoclave? If not how do you sterilize your tools?

Autoclaving is the most thorough form of sterilization if it is done properly and cleaned regularly. But health regulations do not require it. Most salons and spas use chemical sterilants that require a minimum of 20 minutes of soaking. Each technician should have her own solution to ensure proper procedures. This includes foot baths, especially those with jets.

Can I see your autoclave testing log book?

Operators of autoclaves are required to test them weekly for bacteria. There should be a log book showing lab results. If there isn’t, they may not be maintaining the machine adequately.

How do you remove callouses?

Technicians who use razor blades to cut off callouses are taking an unnecessary risk of piercing the skin. Every time the skin is pierced, the risk of infection is very high. The Beauty Council strongly advises against the practice.

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